ADHD and Late Bedtimes Don't Mix for Schoolchildren

Late bedtimes and overall poor sleeping habits can easily transform an A into an F for school-aged children. Sleep is perhaps the most important factor in academic success and healthy cognitive development. Lack of sleep can be disastrous for children, especially if they have attention deficit hyperactivity disorder.

A study in the March issue of the journal SLEEP reports the consequences from poor sleep can magnify the academic disadvantage facing children with ADHD. After staying up late for nearly an extra hour, children with ADHD lost the ability to remain vigilant and attentive.

A group of 11 children with ADHD and 32 kids without the childhood disorder were asked to eliminate nearly an hour of sleep for six consecutive nights, following a baseline period. Researchers monitored the children’s sleep patterns using wrist actigraphy.

Before and after the period of sleep-deprivation, each child took a common neurobehavioral test used in the evaluation of ADHD called a Continuous Performance Test. The children were presented single letters on a computer screen at three different rates and had to press a button in response.

Results show that children with ADHD who lost an average of 55 minutes of sleep per night had more errors and a slower reaction time in the test compared to children without the disorder.

The National Institute of Mental Health reports that ADHD affects about 3-5% of school-aged children, and is more common in boys than girls. Children with ADHD may be impatient, have trouble focusing and quickly become bored. They may daydream, have trouble sitting still or talk nonstop. For a child to be clinically diagnosed with ADHD, these symptoms must be present for at least six months. Sometimes mood disorders such as depression or other learning disabilities are mistaken for ADHD.

Lack of sleep can also lead to symptoms similar to ADHD in children. They respond to sleep loss differently than adults. Sleep-deprived adults may feel lethargic and have trouble staying awake, while sleep-deprived children can be hyperactive.

The AASM recommends school-aged children get 9-10 hours of sleep per night. Very young children may need as much as 14 hours of sleep for healthy cognitive development.

Child Symptoms of ADHD & Sleep Loss Can Be Confused

Australian pediatric sleep expert Dr. Chris Seton recently told the Sydney Morning-Herald that it is very possible to confuse symptoms of ADHD with the effects of sleep deprivation in children.

“A tired five-year-old and a five-year-old with ADHD can both act in the same way," he said. "There's probably a common pathway, but so far researchers have been unable to find what it is."

Last year the Sleep Education Blog reported that children respond to sleep loss in a different way than adults. Sleep-deprived adults tend to be sleepy and sluggish during the day. But sleep-deprived children are often hyperactive.

What could be keeping your child from getting enough sleep? Typically, a combination of biological, social and educational factors.

Recently the Sleep Education Blog reported that children and teens between 8 and 18 years old spend more than 7.5 hours a day watching TV and using electronic devices like cell phones and computers.

Homework, extracurricular activities and time with friends also often cut into sleep time.

Sleep deprivation is linked with behavioral problems and mood disorders in children. Students who are not getting the sleep they need also tend to do worse in school.

How do parents know if their child is sleep deprived? Seton said that a child who can wake up in the morning without an alarm clock is probably getting enough sleep.

ADHD is a serious condition that affects a large number of children. And sleep deprivation is a common alternative explanation for a child’s misconduct. You may want to monitor your child’s sleep habits if you notice changes in his or her behavior.

The AASM recommends that school-aged children sleep between nine and 10 hours each night.

Parents should enforce bedtimes and a nightly routine to help their children get an adequate amount of sleep each night. Sleep experts also recommend keeping the TV and other electronics out of the bedroom.

Learn more about sleep and children. Get help for a sleep problem at an AASM-accredited sleep center near you.

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Bipolar Disorder in Children May Be Linked to a Circadian Clock Gene

A new study found that the circadian clock gene RORB may be involved in bipolar disorder in children.

The study analyzed the genetic make-up of 305 children with bipolar disorder. They were compared with 140 controls.

Results show a positive association between bipolar disorder and four variants of the RORB gene. The authors suggest that this gene may be an important target in the search for the molecular basis of bipolar disorder.

The study also notes that bipolar disorder often involves a decreased need for sleep. This symptom helps discriminate children with bipolar disorder from those with ADHD.

The NIMH reports that bipolar disorder is a brain disorder. It is also known as manic-depressive illness.

It causes unusual shifts in mood, energy, activity levels and the ability to carry out daily tasks. These symptoms tend to be severe.

Bipolar disorder often develops in a person's late teens or early adult years. But some people have their first symptoms during childhood.

The disorder tends to run in families. Children are four to six times more likely to develop bipolar disorder if a parent or sibling has the illness.

Currently there is no cure for bipolar disorder. But ongoing treatment can help control the mood swings and other symptoms.

In 2008 FRONTLINE reported that bipolar disorder was long believed to exist only in adults. But in the mid-1990s it began to be diagnosed at much higher rates in children. Now one million children in the U.S. have been diagnosed with bipolar disorder.

Earlier this year the Sleep Education Blog reported that sleep problems in children may predict the future onset of depression. Learn more about sleep and children.

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Sleep & Hyperactive Boys

A new study examined the link between sleep duration and hyperactivity in preschool children.

The study involved 2,057 mothers in Quebec. They answered annual questionnaires until their child reached 5 years of age.

Results show that nightly sleep duration and hyperactivity were significantly associated. Highly hyperactive children were five times more likely to have a short sleep duration. Short sleepers were four times more likely to have high hyperactivity.

Boys were more likely than girls to be a hyperactive, short sleeper. Other risk factors included living in a low-income home and having a mother with a low education.

“Hyperactivity problems may interfere with night-time sleep,” senior author Jacques Montplaisir said in a news release. “We found that children who didn't sleep long were generally hyperactive boys who lived under adverse family conditions. On the other hand, short or fragmented sleep leads to sleepiness, which could manifest as hyperactivity in boys.”

He also noted that hyperactivity scores were low in young children who slept for at least 11 hours at night.

In September the Sleep Education Blog reported that living in a “fragile family” can affect how children sleep. Another study linked sleep loss to hyperactivity in children.

Earlier this year the Sleep Education Blog reported that children often respond to sleep loss in a different way than adults. Sleep-deprived adults tend to be sleepy and sluggish during the day.

But sleep-deprived children may be hyperactive. This is one key symptom of ADHD. Children with ADHD also may be inattentive or impulsive.

Learn more about sleep and children.

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ADHD & Sleep Disorders in Children

A new study examined sleep problems in children with attention-deficit/hyperactivity disorder.

The Italian study involved 55 children with ADHD. They had an average age of about 9 years. They completed a sleep interview and were monitored during an overnight sleep study.

Results show that most of the children had disturbed, fragmentary sleep at night. The authors found a significant difference in almost all sleep variables between ADHD children and controls.

Fifty percent of the children struggled with restlessness; 21 percent had a complaint of snoring; and about 12 percent had leg discomfort at night related to restless legs syndrome.

Many of the children also had parasomnias. About 48 percent were sleepwalkers; 38 percent had sleep terrors; and almost 29 percent had confusional arousals.

In 52 percent of the children the authors also found an abnormality of the arousal process in slow-wave sleep. Sleepwalking, sleep terrors and confusional arousals typically involve arousals from slow-wave sleep.

The authors suggest that sleep studies should be part of the diagnostic screening for ADHD.

In May the Sleep Education Blog reported that sleep problems also are common in older children and teens with ADHD.

Learn more about sleep and ADHD.

Study Links ADHD to Sleep Problems in Older Children & Teens

A study in the journal Sleep examines sleep problems in older children and teens with attention-deficit/hyperactivity disorder.

Results show that older children and teens are more likely to have a variety of sleep problems if they were diagnosed with ADHD when they were younger. These problems include insomnia, sleep terrors, nightmares, bruxism and snoring.

Study author Dr. Susan Shur-Fen Gau told the AASM that in children some symptoms of ADHD and sleep problems often overlap. These symptoms include inattention, hyperactivity, behavioral problems and impaired academic performance.

“In some patients with ADHD, symptoms are caused or exaggerated by primary sleep disorders,” Shur-Fen Gau said. “Therefore treatment of the sleep disorder will improve ADHD symptoms.”

The study involved 281 children with ADHD. They were between 10 and 17 years of age; they had been diagnosed with ADHD at an average age of 6.7 years. They were compared with 185 children who did not have ADHD.

Nightmares and lifetime nightmare disorder were more common in girls. Snoring was more common in boys.

Learn more about sleep problems and ADHD.

Study Links Sleep Loss to ADHD Symptoms in Children

A new study links sleep loss to behavioral symptoms of attention-deficit/hyperactivity disorder in children.

The study in Finland involved 280 children. They had an average age of 8 years.

Results show that children who slept less than 7.7 hours at night had a higher score for hyperactivity and impulsivity. They also had a higher total score on the ADHD Rating Scale.

The results were significant. But they did not confirm that sleep loss causes ADHD symptoms.

“Intervention studies are needed to confirm the causality,” study author Dr. Juulia Paavonen said in a University of Helsinki statement.

Another recent study found that children with ADHD get about 33 minutes less sleep per night than other children. The AASM reports that children between the ages of 7 and 12 need about nine to 10 hours of sleep per night.

Parents: Pay Attention to Sleep Problems & ADHD

New research continues to examine the link between sleep and attention-deficit/hyperactivity disorder in children.

The latest study appears in the March 1 issue of the journal Sleep. It finds that children with ADHD get about 33 minutes less sleep per night than other children. They also get less rapid eye movement (REM) sleep.

The authors suggest that there may be an underlying sleep problem that is specific to ADHD. So does this mean that sleep problems are the cause of ADHD? Not quite.

“I do not believe that sleep per se is the cause of ADHD, but it may make the symptoms worse in children with sleep problems," said lead author Reut Gruber, PhD.

So sleep problems may cause ADHD-like symptoms. Sleep problems also can make ADHD symptoms more severe. But not every child with ADHD has a sleep disorder.

A common link between sleep problems and ADHD may be sleep deprivation. Children often respond to sleep loss in a different way than adults.

Sleep-deprived adults tend to be sleepy and sluggish during the day. But sleep-deprived children may be hyperactive.

This is one key symptom of ADHD. Children with ADHD also may be inattentive or impulsive.

A recent study in the Journal of Clinical Sleep Medicine reviewed the evidence linking sleep problems to ADHD. Here is what it found.

Restless legs syndrome and periodic limb movements often occur in people with ADHD. Snoring and sleep apnea may contribute to some mild ADHD-like symptoms.

Disorders of “partial arousal” appear to be common in children with ADHD. These include sleepwalking, confusional arousals and sleep terrors.

ADHD seems to be more common in children with rhythmic movement disorder. But this needs to be confirmed by larger studies.

ADHD often involves symptoms of “sleep-onset” insomnia. Children with ADHD may have a hard time falling asleep.

So parents, make sure that your child gets enough sleep for his or her age. Observe how your child sleeps. Discuss any problems with your child’s doctor.

Your child should be screened for a sleep disorder if he or she has ADHD symptoms. Treating an underlying sleep disorder may help your child function better during the day.

Contact an AASM-accredited sleep center for help.